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Results 1951 - 2000 of 2136
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Remme W J - - 1989
Despite a well-established rationale for pharmacologically induced arterial and venous vasodilatation in congestive heart failure, the clinical usefulness of long-term vasodilator therapy without concomitant converting-enzyme inhibition generally has been disappointing. With the exception of nitrates and, possibly, the combination of nitrates and hydralazine, the use of converting-enzyme inhibitors in many ...
Regan T J - - 1989
A number of experimental and clinical studies have indicated that the process of aging and diabetes mellitus may result in alterations of cardiac function and composition. These appear to be independent of myocardial ischemia. Left ventricular diastolic compliance is diminished in both situations associated with interstitial collagen accumulation. There is ...
Chakko S C - - 1989
The therapeutic course of patients with severe heart failure can be complicated by disturbances in potassium homeostasis. Although hypokalemia in more prevalent, hyperkalemia may occur. Among 730 consecutive patients admitted to the hospital because of heart failure, nine episodes of acute, life-threatening hyperkalemia (mean serum potassium level: 7.2 +/- 0.5 ...
Gottlieb S S - - 1989
STUDY OBJECTIVE: To evaluate the hemodynamic effects of the antiarrhythmic drug, encainide, in patients with severe chronic heart failure. DESIGN: Unblinded, before-after study. SETTING: Referral center for patients with heart failure. PATIENTS: Thirty patients with severe chronic heart failure and a left ventricular ejection fraction less than 40%. INTERVENTIONS: Invasive ...
Parmley W W - - 1989
Congestive heart failure is a common clinical syndrome, with a relatively poor prognosis in its advanced stages. During the development of heart failure, there is a decline in myocardial contractility and activation of neurohormonal systems. An overshoot of some of these compensatory mechanisms sets the stage for therapeutic interventions. Any ...
Katz A M - - 1989
Forty years ago therapy for congestive heart failure was limited largely to the mercurial diuretics and a variety of cardiac glycoside preparations; these were often ineffective, and the common practice of "pushing" digitalis caused serious, sometimes lethal side effects. Today, a more complete understanding of the regulation of cardiac work ...
Asanoi H - - 1989
OPC-8212, a newly synthesized noncatecholamine, nonglycosidic, orally effective inotropic agent, has been shown to exert a potent cardiotonic action in acute administration to patients with heart failure. However, its long-term effect has not yet been established. Eight patients with dilated cardiomyopathy (New York Heart Association functional class II-III) were given ...
Borek M - - 1989
Recognition of the importance of the renin-angiotension-aldosterone system in heart failure, along with an appreciation of the hemodynamic benefits of vasodilator therapy has led to the widespread use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure. The ACE inhibitors are the only class of vasodilator agents shown ...
Cavalli A - - 1989
The substitution of digoxin with ibopamine, a new inotropic and vasodilating agent, was evaluated in a multicenter study in 58 patients with mild-to-moderate congestive heart failure, stabilized on diuretics, and digoxin therapy. The study was a parallel, double-blind, randomized trial of four weeks duration in which half of the group ...
Redington A N - - 1989
The place of digoxin in the pediatric cardiologist's armamentarium remains uncertain. As an antiarrhythmic, its use in the Wolff-Parkinson-White syndrome is obsolete, but it remains useful in the treatment of the chronic atrial fibrillation seen in some patients postoperatively and in children with dilated cardiomyopathy. The efficacy of digoxin in ...
Nasraway S A - - 1989
We studied the inotropic response to dopamine and digoxin in 20 patients with severe sepsis and left ventricular failure. Left ventricular failure was defined as a left ventricular stroke work index less than or equal to 40 g.m/m2 at a pulmonary artery wedge pressure greater than or equal to 15 ...
Chatterjee K - - 1989
Hemodynamic studies are useful in the diagnosis of the pathophysiologic mechanisms of pump failure and low output state in patients with acute heart failure. Hemodynamic monitoring is extremely useful for the appropriate manipulation of the vasoactive drugs to optimize hemodynamic and clinical improvement of patients with acute heart failure and ...
Cody R J - - 1989
Despite the interest in neurotransmitter and hormonal influences in heart failure in the last decade, the issues surrounding their contribution to the pathophysiology of congestive heart failure have become more complex. This must be considered in view of the pathway of hormonal stimulation and inhibition (Fig. 3) and the multiple ...
Todd P A - - 1989
Enalapril provides significant haemodynamic, symptomatic and clinical improvement when added to maintenance therapy with digitalis and diuretics in patients with congestive heart failure [NYHA (New York Heart Association) classes II to IV]. These effects are not attenuated during long term therapy. More significantly, a clinical study demonstrated that enalapril reduces ...
Chatterjee K - - 1989
Digitalis therapy is usually ineffective in heart failure complicating myocardial infarction but may be of benefit in some selected patients with chronic heart failure. However, digitalis therapy in the long-term should be considered in conjunction with vasodilators or ACE inhibitors. This article reviews the practical and clinical aspects of vasodilator ...
Packer M - - 1989
Controlled and uncontrolled hemodynamic and clinical studies have noted that the long-term treatment of patients with chronic heart failure with phosphodiesterase (PDE) inhibitors, such as amrinone, milrinone, enoximone and imazodan, may accelerate progression of the underlying disease and provoke serious ventricular arrhythmias. However, in an experimental model of chronic progressive ...
Katz A M - - 1989
It is now apparent that the myocardium in patients with congestive heart failure (CHF) is not normal, because important structural and molecular changes modify function in these hearts. It appears likely that the myocardium in these patients with CHF becomes unable to provide enough chemical energy to meet its mechanical ...
Pouleur H - - 1989
Xamoterol 200 mg twice daily was given for 2 months to nine patients with severe heart failure already being treated with angiotensin converting enzyme (ACE) inhibitors. Left ventricular end-diastolic pressure fell from 28 to 13 mmHg and end-systolic volume fell from 115 to 106 ml m-2; indices of contractility improved ...
Taylor S H - - 1989
Heart failure is a complex cardiovascular syndrome affording many pharmacotherapeutic targets. Ibopamine affords a unique pharmacological profile for the treatment of this complex syndrome by virtue of its ability to stimulate DA-1 and DA-2 receptors in the vasculature in combination with its beta 2-agonist activity. The drug has been shown ...
Berko B A - - 1989
As with other cardiovascular diseases, there are sufficient data to suggest significant gender-related differences in the prevalence and presentation of congestive heart failure and myocardial diseases. From animal studies, it is apparent that there are sex-related differences in intrinsic ventricular function and in the cardiovascular response to various stimuli, which ...
Vrobel T R - - 1989
Abnormalities of mental function are common problems in patients with congestive heart failure, a problem that is often referred to the consulting psychiatrist. These abnormalities become more frequent and more serious as failure of the heart progresses and they can exhibit a wide variety of manifestations. Cardiac output and cerebral ...
Francis G S - - 1989
Congestive heart failure is emerging as an important public health problem because of its frequency and high mortality. Over the past decade, a number of clinical trials have been launched in a systematic attempt to determine an optimal therapeutic strategy for the treatment of heart failure. There appears to be ...
Parmley W W - - 1989
Patients with symptoms of congestive heart failure look to treatment to relieve symptoms, improve the quality of life, and prolong life. They prefer a convenient dosing schedule, with minimal side effects and low cost. A wide variety of agents are available to treat patients with congestive heart failure. The three ...
Antman E M - - 1989
After more than two centuries of administration of digitalis glycosides to patients with cardiac disease, empirical observation and tradition remain the basis for much of the clinical application of these drugs. Many questions remain, and the role of digitalis in the management of congestive heart failure and cardiac rhythm disturbances ...
Riegger A J - - 1989
The renin-angiotensin-aldosterone system plays an important role in the development of congestive heart failure (CHF). In patients with chronic heart failure, angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, and quinapril, have been shown to improve hemodynamics, reduce symptoms of fatigue and dyspnea, increase exercise capacity, correct hyponatremia, reduce diuretic ...
Erdmann E - - 1989
The different pathophysiological causes of acute and chronic heart failure prohibit a simple therapeutic approach with only one type of drug. Recent investigations have shown that the judicious use of positive inotropic agents, diuretics, and vasodilators in addition to dietary and exercise therapy can relieve the symptoms of heart failure ...
Hernández López E - - 1989
The data herein presented provides persuasive evidence that in addition to diuretics, and probably digitalis (since all studies have included subjects taking this drug) patients with congestive heart failure should also be placed on a vasodilator regimen to slow the progression of the syndrome and to reduce its mortality. Firm ...
Cargnelli G - - 1989
The rationale of combining vasodilatation with positive inotropic intervention in the treatment of chronic heart failure has found a new implementation in the "inodilator" drugs. Inodilators are characterized by the properties of exerting positive inotropic effect and inducing systemic vasodilatation. The cellular mechanisms involved in the regulation of contractility of ...
Packer M - - 1989
Controlled trials using modern methods of assessment in well-defined groups of patients have now convincingly demonstrated that digitalis is an effective and well-tolerated drug in patients with chronic heart failure who have left ventricular systolic dysfunction. These encouraging findings concerning digitalis, however, should not be construed to suggest that the ...
Shabetai R - - 1989
The prevalence of coronary artery disease shows no signs that it is declining, yet mortality is decreasing and advanced methods of treatment are creating a large population of individuals with a substantially damaged left ventricle. Clinical observations and experimental data provide convincing evidence that postischemic damage is progressive even in ...
Kostis J B - - 1988
Since their introduction in clinical practice in 1980, ACE inhibitors have been found useful in the treatment of hypertension and CHF. In hypertension, they are effective as monotherapy in 40% to 50% of the patients, and in combination with diuretics or calcium antagonists, they are effective in up to 85% ...
Lund O - - 1988
From 1979 through 1986, 90 patients required intraaortic balloon pumping (IABP) due to low cardiac output complicating open heart surgery. Preoperatively, functional class III or IV was present in 92%; in patients with coronary artery disease (n = 54), three-vessel or left main disease was found in 72%; patients with ...
Jessup M - - 1988
Congestive heart failure, a constellation of signs and symptoms that result from the heart's inability to provide sufficient oxygenated blood to metabolizing tissues, is a major cause for concern in the elderly. The prognosis is ominous, with a 10% per year mortality rate after the initial CHF episode, and a ...
Cohn J N - - 1988
Myocardial dysfunction eventuating in systolic and diastolic pump function abnormalities is a consequence of a wide variety of cardiac diseases. The symptoms that develop in this syndrome appear to be related as much to peripheral and neurohormonal mechanisms as to the underlying pathological and cardiac functional abnormality. Relief of symptoms, ...
Meinertz T - - 1988
Annual mortality from congestive heart failure ranges from 15% to 60%, depending on the severity of the left ventricular damage and underlying disease. Most controlled trials have been too small to detect any beneficial effect on survival from the newer vasodilator and inotropic drugs. However, the results of two recent ...
Firth B G - - 1988
The angiotensin converting enzyme (ACE) inhibitors constitute a major breakthrough in the medical management of congestive heart failure. The incidence of side effects with these agents is surprisingly low when they are used in the appropriate dosage. They produce sustained beneficial hemodynamic and symptomatic improvement in most patients with congestive ...
Papadakis M A - - 1988
PURPOSE: Digoxin is the third most commonly prescribed drug, yet limited information exists about its use in outpatients. Therefore, 242 medical outpatients receiving digoxin at our hospital were studied to evaluate the appropriateness of its use, defined by: (1) current or past supraventricular arrhythmias and/or (2) left ventricular systolic dysfunction ...
Yancy C W CW - - 1988
Congestive heart failure (CHF) is not a single entity but a symptom complex that may represent the consequence of mechanical abnormalities, myocardial abnormalities, and/or disturbances of cardiac rhythm. In turn, it affects virtually every organ system in the body. This review focuses on CHF due to systolic dysfunction of the ...
McAlpine H M - - 1988
The extent of neuroendocrine activation, its time course, and relation to left ventricular dysfunction and arrhythmias were investigated in 78 consecutive patients with suspected acute myocardial infarction. High concentrations of arginine vasopressin were found within six hours of symptoms, even in the absence of myocardial infarction (n = 18). Plasma ...
Francis G S - - 1988
Congestive heart failure is a complex clinical syndrome characterized by a number of neuroendocrine responses. These responses are probably an evolutionary vestige of mechanisms designed to defend volume and maintain circulatory homeostasis. Activation of the sympathetic nervous system and renin-angiotensin-aldosterone system and the release of vasopressin have been clearly documented ...
Cleland J G - - 1988
The prognosis in patients with heart failure secondary to left ventricular dysfunction is poor. Although survival can be related to the extent of cardiac functional impairment, many patients die suddenly rather than in refractory heart failure. Ambulatory electrocardiography has revealed a high prevalence of simple and complex ventricular arrhythmias in ...
Oakley C - - 1988
Failure of the right ventricle may be due to a congenital anomaly, intrinsic disease, pulmonary stenosis or pulmonary hypertension. Left ventricular failure may also lead to right ventricular failure if the heart fails totally or secondary to pulmonary hypertension, or if filling of the right ventricle is decreased due to ...
Poole-Wilson P A - - 1988
The most common symptoms of patients with heart failure are shortness of breath and fatigue. The causes of these symptoms may be different in various entities encompassed by the general term heart failure, such as acute pulmonary edema, circulatory collapse and chronic heart failure. In patients with acute heart failure, ...
Katz A M - - 1988
There is substantial, although not yet conclusive, evidence that the failing heart is in an energy-depleted state. Such an imbalance between energy production and energy utilization would have important implications for the management of patients with congestive heart failure (CHF), most important of which is that therapeutic measures that increase ...
Chatterjee K - - 1988
Benefits from vasodilator therapy in patients with chronic heart failure are partly related to the severity of functional derangements. Agents with an arteriolar-dilating effect are more likely to be effective in patients with higher left ventricular outflow resistance. Vasodilators with primary venodilating properties are more likely to be effective in ...
Nicholls M G - - 1988
The renin-angiotensin system is activated in heart failure in proportion to the severity of the haemodynamic derangement and to diuretic dose. Angiotensin converting enzyme (ACE) inhibitors reduce circulating levels of angiotensin II and aldosterone and, in some patients, plasma noradrenaline, vasopressin and cortisol. Typically there is potassium retention and a ...
Lindpaintner K - - 1988
The emerging recognition of the existence and potential biological significance of local tissue renin-angiotensin systems in a number of organs has fostered interest in a possible intrinsic cardiac renin-angiotensin system. Evidence for such a system was first provided by biochemical measurements of components of the renin-angiotensin system in cardiac tissue. ...
Kübler W - - 1988
Vasodilators are widely used in the therapy of congestive heart failure. Different mechanisms responsible for a failure of vasodilator therapy are discussed. Tolerance and/or diminished reabsorption or a less than optimal choice of the drug may be responsible for the lack of acute response. In addition, counter-regulation, mainly by the ...
Cantelli I - - 1988
Therapy combining vasodilators and inotropic agents is considered to be one of the most powerful means of improving cardiac function in patients with congestive heart failure (CHF). The vasodilators enhance the effectiveness of inotropic agents by providing a reduction in preload and/or afterload. Inotropic drugs with different mechanisms of action, ...
Massie B M - - 1988
Although the underlying pathophysiology in most patients with congestive heart failure is impaired myocardial contractility, hemodynamic and clinical benefit can be achieved by treatment with agents that alter the loading conditions of the left ventricle. This was initially accomplished with direct-acting vasodilators such as sodium nitroprusside, nitrates, and hydralazine. Subsequently, ...
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